Healthcare for Women: Should be big agenda for Elections 2014

Healthcare for Women: Should be big agenda for Elections 2014

Sucheta Tiwari

Sucheta Tiwari is an MSc Global Health Science student in the Oxford
University Nuffield Department of Population Health. She completed her
MBBS from Lady Hardinge Medical College, New Delhi.

The three waves of feminism seem to have overlooked the Indian
shores. We are a country where any conversation about gender issues
tends to get lost within layers of complexities ranging from
predominantly patriarchal societal norms to misrepresentation of women
in government offices. The issue of women’s health weaves through all of
these layers and emerges as one of the most complex, yet one of the
most poignant issues of the day. Mr. K.D. Singh brought up the issue of
sanitation and drinking water facilities in his post. I will try to
delve deeper into the healthcare issues of Indian women.

Indian healthcare stands on a unique ground for a variety of reasons,
the most obvious one being the lack of a well defined healthcare
system. The rural-urban divide in healthcare facilities is
representative of the dichotomous nature of almost all aspects of living
in India. The uniqueness of our position does not end at a gaping chasm
between the preventive and treatment facilities available to the
populations in these areas: it extends to the disease spectrum that our
population is heir to. On the one hand we have one of the heaviest
burdens of lifestyle diseases like diabetes mellitus and cardiovascular
disease, and on the other hand our infant mortality rate and our
maternal mortality rate remain among the worst in the world. While the
prevalence of diseases like cancer requires cutting edge medical science
for control, we also have heavy disease burdens of completely
manageable conditions like malaria, dengue, malnutrition and anaemia.

Add to this the unique position the Indian woman finds herself in.
That our society’s patriarchal methods have led to disastrous
consequences for women is seen statistically in our persistently skewed
sex ratios. Female foeticide still remains at large despite the Pre
Natal Diagnostic Techniques Act coming into effect nearly twenty years
ago. Our maternal mortality has improved slightly and we are now at 212
maternal deaths per 100,000 per year; but this is far from the MDG
target of 109 by 2015. (We are much closer to attaining the MDGs in
areas like Infant Mortality, HIV/AIDS control, Malaria management: which
probably hints at inadequate efforts invested in understanding the
situation of maternal mortality in India).

Even when we put gender-specific public health issues aside, Indian
women are faced with a plethora of completely preventable but utterly
mismanaged conditions. Seventy-five per cent of pregnant women are
anaemic from low levels of iron. In a country that can’t really boast of
basic public amenities for sanitation, it is the women that bear the
brunt of our Open-Toilet culture. From the obvious public health
disaster that an undeveloped sewage disposal system is to the lack of
menstrual hygiene, the problem of sanitation in women creates a domino
effect that affects not only their health and the health of their
children; it also results in adolescent girls dropping out of school for
fear of embarrassment.

This brings me to the taboos associated with womanhood that have
ingrained themselves in our culture. Menstruation is shameful, sex
education is a far cry from reality, and domestic violence in most
segments of the society is so well-rooted that it is considered a way of
life. The infamous Delhi gang rape case of last December brought about
social mobilization that, if sustained, can be the beginning of change.
But it’s important to realize that violence is as much a public health
issue as it is a social one. The signs of violence need to be
identified, proper medical care systems- both physical and mental- need
to be in place for victims of violence. Most importantly, public health
campaigns to promote awareness of ongoing violence and human rights
movements at the grassroots level need to be targeted towards women, so
that they can take charge of their own lives- the one thing that hasn’t
happened in sixty six years of independence.

While health policies like the Janani Suraksha Yojana are a great way
to promote safe healthcare practices among women, monitoring their
efficacy is vital if any real change is to be brought about. Training
Anganwadi workers, ASHAs and ANMs in the community has been a good step
to empower women while improving the health of their communities. But
again, even with regular training programs in place, their actual
efficacy must be monitored by an external agency if we want to see
results. Without an actual measure of the results that a policy brings
about, all policymaking is mere tokenism in the name of governance.

It is well known that several healthcare plans have been put forward
by the planning commission; most of them are well rounded and well
researched initiatives. The real problem lies in their implementation or
lack thereof. WHO recommends that governments spend at least 5% of
their GDP on healthcare. In India’s fledgling attempts to achieve this,
we have only managed to spend 3.9% of our GDP on healthcare- an even
lesser amount on issues specific to women. Funding is only one part of
the picture. We need people working at the grassroots level on issues of
sanitation, safe births, violence, nutrition- and we need impartial,
third-party review of their work.

The issue of women’s health as a whole needs to be broken down into
components. We need the government to work in collaboration with NGOs,
individuals and organizations with vested interest on these components.
And we need periodic reviews of the larger picture for targeted
improvement. While the problem may seem insurmountable, it can be
tackled by persistent dedication and action.